Posters

Extended removal of continuous curvilinear capsulorhexis including fungal lesions in a Stevens-Johnson patient after cataract surgery

Poster Details

First Author: H.Fukuoka JAPAN

Co Author(s): H. Yoshioka K. Yoneda C. Sotozono

Abstract Details

Purpose:

Stevens-Johnson Syndrome (SJS) patients often have abnormal conjunctival microbial flora, such as Methicillin Resistant Staphylococcus Aureus, resulting from compromised immune systems. The purpose of this study is to report the surgical treatment of fungal endophthalmitis in a SJS patient after cataract surgery.

Setting:

Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Methods:

A 59-year-old female, who had developed SJS at 22 years old after being prescribed antibiotics to treat cystitis, underwent vision-restoring cataract surgery. She had shortened conjunctival fornices, inferior conjunctival growth extending into cornea, and a history of conjunctival autograft transplantation for corneal perforation at 55 years old. However, the cornea around the pupillary zone was still clear pre-operatively. She has received oral intake of Methylprednisolone for allergic disease at other hospital. The conjunctival bacteriological examination before cataract surgery revealed Candida. Therefore, she received Miconazole eye drops before surgery.

Results:

Postoperatively, she received Levofloxacin and Betamethasone eye drops in addition to oral intake of Betamethasone and Cyclosporine to control ocular surface inflammation. She received more Betamethasone eye drops because anterior chamber inflammation and keratic precipitates appeared 2 months after cataract surgery. Despite therapy, they worsened, and white lesions on the edge of the inferior, continuous curvilinear capsulorrhexis were found. Notwithstanding reinitiating Miconazole eye drops in addition to Natamycin ointment, the keratic precipitates did not improve. The decision was made to pursue surgical treatment including extended removal of residual, continuous curvilinear capsulorrhexis to remove the white lesions.

Conclusions:

Extended removal of residual, continuous curvilinear capsulorrhexis including the white lesions was performed two times. As a result, she was cured with no recurrence of infection after surgeries. Bacteriological analysis of the white lesions identified Candida. We speculate the source of the fungus was conjunctival because the same Candia species was isolated from analysis of the conjunctiva and white lesions. We feel the most likely mechanism of intraocular contamination includes tears infiltrating the injection cartridge and/or residual cortex on the edge of inferior anterior capsule.